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Benefit-risk Assessment for Including Dairy Foods in the Diet

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Consumption of milk and milk products is an important component of a healthy diet. It is recommended by the Dietary Guidelines for Americans to consume 3 cups per day of fat-free or low-fat milk or equivalent milk products. The benefits of milk and milk products outweigh the perceived risks. If milk is avoided in a diet, careful planning and monitoring is needed to assure adequate essential nutrients such as calcium, vitamin D, potassium, and magnesium. Calcium and vitamin D adequacy is critical to bone health, especially the prevention of osteoporosis.

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Benefit-risk Assessment for Including Dairy Foods in the Diet

  1. 1. Benefit-risk Assessment for Including Dairy Foods in the Diet <ul><li>Melissa Nickle </li></ul><ul><li>In conjunction with Kristen Nilsson Farley </li></ul><ul><li>Nutrition 577 </li></ul><ul><li>December 2009 </li></ul>
  2. 2. Abstract <ul><li>Consumption of milk and milk products is an important component of a healthy diet. It is recommended by the Dietary Guidelines for Americans to consume 3 cups per day of fat-free or low-fat milk or equivalent milk products. The benefits of milk and milk products outweigh the perceived risks. If milk is avoided in a diet, careful planning and monitoring is needed to assure adequate essential nutrients such as calcium, vitamin D, potassium, and magnesium. Calcium and vitamin D adequacy is critical to bone health, especially the prevention of osteoporosis. </li></ul>
  3. 3. Learning Objectives <ul><li>Comprehend the background of the dietary guidelines and know what their recommendations are for milk and milk products </li></ul><ul><li>Become familiar with the health benefits of milk and milk products </li></ul><ul><li>Gain insight to the perceived risks of milk consumption </li></ul>
  4. 4. The 2005 Dietary Guidelines for Americans <ul><li>Composed by scientific experts who were responsible for reviewing and analyzing the most current dietary and nutritional information and incorporating this into a scientific evidence based report 1 . </li></ul><ul><li>Advice to promote health and to reduce risk of major chronic diseases through diet and physical activity 1 . </li></ul><ul><li>A specific disease linked to poor diet and lack of physical activity is osteoporosis 1 . </li></ul><ul><li>The intent is to integrate knowledge regarding individual nutrients and food components into recommendations for a pattern of eating that can be adopted by the public 1 . </li></ul>
  5. 5. The 2005 Dietary Guidelines for Americans cont. <ul><li>Recommends 3 cups per day of fat-free or low-fat milk or equivalent milk products 1 . </li></ul><ul><li>Documented intake levels of calcium, potassium, and magnesium are among the shortfall nutrients for adults and children 1 . </li></ul><ul><li>Dairy products provide a substantial portion of calcium, potassium, and magnesium 1 . </li></ul><ul><li>Indicates that low intakes of calcium tend to reflect low intakes of milk and milk products 1 . </li></ul><ul><li>Identifies milk and milk products as a major contributor of dietary potassium and lists dairy consumption, along with fruits and vegetables, as food groups to encourage 1 . </li></ul>
  6. 6. Benefits of Milk and Milk Products <ul><li>Is fortified with vitamin D in the U.S. Vitamin D is important for optimal calcium absorption, and it can reduce the risk for bone loss 2 . </li></ul><ul><li>3 cups of vitamin-D fortified milk contains 300IU’s of vitamin-D (75% of RDA) 3 . </li></ul><ul><li>Milk intake is especially important to bone health during childhood and adolescence 4 . </li></ul><ul><li>Studies specifically of milk and other milk products show a positive relationship between the intake of milk and milk products and bone mineral density in one or more skeletal sites 4 . </li></ul>
  7. 7. Benefits of Milk and Milk Products cont. <ul><li>Most economical source of many key nutrients 4 . </li></ul><ul><li>Milk and milk products provide more than 70% of the calcium consumed by Americans 5 . </li></ul><ul><li>Contributes to essential nutrients, especially calcium, potassium, and magnesium 1 . </li></ul>Chart from National Dairy Council 6
  8. 8. Benefits of Milk and Milk Products cont. <ul><li>Positively associated with bone health because of their calcium content. Bone mineral content is one-third calcium, and low calcium intake leads to increased bone remodeling and increased risk of hip fracture 7 . </li></ul><ul><li>Vegans who exclude dairy products in their diets have reduced bone mineral density and increased incidence of fracture 8 . </li></ul><ul><li>Also, lowers the risk of developing insulin resistance syndrome by 21% 9 . </li></ul>
  9. 9. Perceived Risks of Milk and Milk Products <ul><li>Protein-induced calciuria associated with bone loss </li></ul><ul><ul><li>Milk adds 8g of protein/cup, however overall calcium retention is unaffected by protein amount or type 10-12 . </li></ul></ul><ul><li>Presence of steroid hormones </li></ul><ul><ul><li>17 β -estradiol is very low in whole milk (1.4 ± 0.2 pg/mL) and would be even lower in skim milk since it is based on fat value 13 . </li></ul></ul><ul><li>Prostate Cancer </li></ul><ul><ul><li>Some epidemiologic studies have shown a relation between dairy consumption and prostate cancer risk 14 , yet more recent studies have shown no relation or a reduction of risk with consumption 15,16 . </li></ul></ul>
  10. 10. Conclusion <ul><li>The current guidelines are made to ensure adequate calcium intake and are grounded in strong science. </li></ul><ul><li>Calcium intake is currently insufficient in the US, where osteoporosis is a major and rapidly growing public health problem 17 . </li></ul><ul><li>It is possible to consume adequate dietary calcium without dairy products, however doing so requires nutrient knowledge, planning, and monitoring. </li></ul><ul><li>Milk is an inexpensive source of high-quality, essential nutrients 17 . </li></ul>
  11. 11. Conclusion cont. <ul><li>Milk is fortified with vitamin D and is currently the only significant food source of vitamin D. Vitamin D is critical for the absorption of calcium and particularly important during the winter months 17 . </li></ul><ul><li>American Cancer Society advises to consume recommended levels of calcium primarily through food sources such as low-fat or non-fat dairy products 18 . </li></ul>
  12. 12. References <ul><li>U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th Edition, Washington, DC: U.S. Government Printing Office, January 2005. </li></ul><ul><li>Holick MF. Vitamin D. In: Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ, eds. Modern Nutrition in Health and Disease, 10th ed. Philadelphia: Lippincott Williams & Wilkins, 2006. </li></ul><ul><li>U.S. Department of Agriculture, Agricultural Research Service. USDA Nutrient Database for Standard Reference, Release 22, 2009. </li></ul><ul><li>Weaver CM. Should dairy be recommended as part of a healthy vegetarian diet? Point. Am J Clin Nutr 2009; 89(suppl):1634S-7S. </li></ul><ul><li>Hiza, HAB. Bente L, Fungwe. Nutrient Content of the U. S. Food Supply, 2005. (Home Economics Research Report No. 58). U.S. Department of Agriculture, Center for Nutrition Policy and Promotion. </li></ul><ul><li>National Dairy Council. http://www.nationaldairycouncil.org/NR/rdonlyres/BF4E114A-E9D5-4BD1-9858-E712E6B4ECA7/0/ImproveDietQualitywithDairyFINAL102209.pdf </li></ul><ul><li>Kalkwarf HJ, Khoury JC, Lanphear BP. Milk intake during childhood and adolescence, adult bone density, and osteoporotic fractures in US women. Am J Clin Nutr 2003; 77:257-65. </li></ul><ul><li>Appleby P, Roaddam A, Allen N, Key T. Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford. Eur J Clin Nutr 2007; 61:1400-6. </li></ul><ul><li>Elwood PC, Pickering JE, Fehily AM, Hughes J, Ness AR. Milk drinking, ischaemic heart disease and stroke. I. Evidence from cohort studies. Eur J Clin Nutr 2004; 58:711-7. </li></ul>
  13. 13. References <ul><li>Kerstetter JE, O’Brien KO, Caseria DM, Wall DE, Insogna KL. The impact of dietary protein on calcium absorption and kinetic measures of bone turnover in women. J Clin Endocrinol Metab 2005;90:26-31. </li></ul><ul><li>Roughead ZK, Johnson LK, Lykken GI, Hunt JR. Controlled high meat diets do not affect calcium retention or indices of bone status in healthy postmenopausal women. J Nutr 2003; 133:1020-6. </li></ul><ul><li>Spence LA, Lipscomb ER, Cadogan J, et al. The effect of soy protein and soy isoflavones on calcium metabolism and renal handling in postmenopausal women: a randomized crossover study. Am J Clin Nutr 2005; 81:916-22. </li></ul><ul><li>Pape-Zambito DA, Magliaro AL, Kensinger RS. Concentrations of 17 β -Estradiol in Holstein whole milk. J Dairy Sci 2007; 90:3308-13. </li></ul><ul><li>Wu K. Hu FB, Willett WC, Giovannuci E. Dietary patterns and risk of prostate cancer. Cancer Res 2006; 15:167-71. </li></ul><ul><li>Park Y, Mitrou PN, Kipnis V, Hollenbeck A, Schatzkin A, Leitzmann MF. Calcium, dairy foods, and rick of incident and fatal prostate cancer: the NIH-AARP Diet and Health Study. Am J Epidemiol 2007; 166:1270-9. </li></ul><ul><li>Neuhouser ML, Barnett MJ, Kristall AR, et al. (n-6) PUFA increase and dairy foods decrease prostate cancer risk in heavy smokers. J Nutr 2007; 137:1821-7. </li></ul><ul><li>Goldberg JP, Folta SC, Must A. Milk: can a ‘good’ food be so bad? Pediatrics 2002; 110:826-832. </li></ul><ul><li>Kushi LH, Byers T, Doyle C, et al. CA Cancer J. Clin 2006; 56:254-262. </li></ul>

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